Mechanical Circulatory Support with the Transaortic Impella LD for Postcardiotomy Cardiogenic Shock at Heart Center Dresden (the Early, the Better Concept)

Background: Cardiogenic shock after cardiac surgery is accompanied by a high mortality rate. Early institution of hemodynamic support with a versatile, easy to insert left ventricular assist device might help bridge patients to recovery or to the next therapy, and improve the outcomes. Although veno-arterial ECMO has been used as mechanical circulatory support in patients with postcardiotomy cardiogenic shock (PCCS), it is associated with a high rate of complications and poor quality of life. The Impella LD are minimally invasive left ventricular assist devices that provide effective hemodynamic support resulting in left ventricular unloading and systemic perfusion. Our goal was to describe the outcome of patients with PCCS supported with the Impella LD at heart center Dresden.

Method: We retrospectively reviewed consecutive patients supported with the Impella LD for PCCS between October 2019 and June 2021. Survival outcome and in-hospital complications were assessed.

Results: A total of five patients (62 ± 6 years, 20% women) with PCCS were supported with the Impella LD. At baseline, 80% experienced chronic heart failure (ICM, DCM). The mean EuroSCORE II was 4.2 ± 1.2 and the ejection fraction was 23 ± 6%. TAPSE was 16.6 ± 2. The majority of patients underwent coronary artery bypass grafting (60%) or combined surgery (20%). The pump provided an average of 3.7 ± 0.5 L/min of flow. The duration of ITN was in 60% ˂ 12 hours. The mean duration of Impella LD support was 138 ± 44 hours. There was no bleeding, no stroke, and no device problem or displacement. Weaning from the Impella was successful in 80%, and 60% survived to discharge. Recovery of native heart function was observed in 100% of discharged patients. Survival to 30 days and to 6 months from Impella implant was 60 and 60%, respectively.

Conclusion: Transaortic Impella LD insertion is safe and effective and technically easy to implant in postcardiotomy patients with cardiogenic shock, when it is implanted at a proper time before cardiac reserve is exhausted (the early the better concept). Implantation is guided by transesophageal echocardiography without radiation exposure or call for interventional cardiologist help. These options enhance the early recovery and early mobility of the patient. Impella LD actively unloads the LV, rapid restoration of normal end-organ perfusion (3–5 L/min) and increases the coronary perfusion, thereby improving the myocardium oxygen supply/demand ratio.

Publication History

Article published online:
03 February 2022